[Using peripheral perfusion index and venous-to-arterial CO(2) difference/arterial-central venous O(2) difference ratio to assess lactate clearance in septic patients after resuscitation].

Objective: The relationship of venous-to-arterial CO(2) difference(Pv-aCO(2))/arterial-central venous O(2) difference (Ca-vO(2)) ratio, peripheral perfusion index(PI) and lactate clearance(LC) were investigated during resuscitation in septic patients. And, the meaning of the combination PI and Pv-aCO(2)/Ca-vO(2) ratio to interpret incoherence of lactate clear was explored. Methods: The patients with sepsis were prospectively observed, who admitted to critically care medicine department of Peking Union Medical College Hospital. The hemodynamic parameters, simultaneous arterial and central venous blood gas analysis and PI were obtained at the enrollment (T0) and 8 hours (T8) during resuscitation. The lactate clearance was defined as 8h-LC≥10% and non-lactate clearance was defined as 8h-LC ≤ 10%. Additionally, the patients were divided as three sub-groups according to the PI value at T8: the normalized PI group with PI≥1.4,the mild impaired PI with 1.40.05），PI≤0.6者具有显著升高的Pv-aCO(2)。复苏8 h后PI≥1.4乳酸清除<10%者Pv-aCO(2)/Ca-vO(2)比值高于乳酸清除≥10%者（1.9±0.7比1.3±1.0, P=0.01）。多因素回归分析显示，复苏8 h后Pv-aCO(2)/Ca-vO(2)比值[Exp（B）2.235，95% CI 1.232~ 4.055，P=0.008]、急性生理与慢性健康状况评分Ⅱ[Exp（B）1.087，95%CI 1.022~1.156，P=0.008]是乳酸清除<10%的独立危险因素。复苏8 h后PI与Pv-aCO(2)呈负相关（r=-0.311，P=0.004），与Pv-aCO(2)/Ca-vO(2)比值无相关性（r=-0.094，P=0.385）。 结论： 脓毒症复苏过程中，纠正异常的Pv-aCO(2)/Ca-vO(2)比值和PI有助乳酸清除。联合Pv-aCO(2)/Ca-vO(2)比值和PI有助于评价乳酸清除失协调。.